Tuesday, July 25, 2017

Hooked

Author Maia Szalavitz first injected cocaine in the mid-1980s at the age of twenty. “My mind was rapidly overcome by a crystalline euphoria,” she writes, “a bliss that was surprisingly satisfying.” She’d recently been suspended from Columbia University in New York City for dealing drugs, and within weeks of her first injection she was doing “speedballs,” an intravenous combination of cocaine and heroin.

That fall she was arrested by plainclothes narcotics agents for possession of more than two kilos of cocaine. Two years later, while out on bail, she chose to get treatment, and she completed a twenty-eight-day inpatient rehab program in 1988. Over the next four years, while she attended twelve-step meetings and made court appearances, she received her undergraduate degree in psychology from Brooklyn College and freelanced for The Village Voice and Spin.

The charges against Szalavitz, which carried a fifteen-year minimum sentence, were eventually dropped. She acknowledges that her status as a privileged white woman contributed to this outcome and writes about feeling “obligated to do all I can to make sure that others are able to be treated with similar mercy.”

Today the fifty-two-year-old is a columnist for Vice and freelancer for such publications as Time, The New York Times, The Washington Post, and Scientific American, specializing in neuroscience and addiction-related issues. Her “detour,” as she calls it, through the world of drug addiction has allowed her to cover the topic with empathy and the insight of firsthand experience.

Cooper: How do you define addiction?

Szalavitz: I define it as a compulsive behavior that continues despite negative consequences. This is also the definition used by the National Institute on Drug Abuse. A negative consequence could be anything from falling down drunk, to losing a job, to going to jail. People usually respond to negative consequences by changing their behavior, but when addiction is involved, they are more likely to try to avoid making the connection between the drug use and the consequences.

Now, in order to succeed in life, you need to be able to persist despite negative consequences in many situations. I couldn’t survive as a writer, for example, if I weren’t able to deal with rejection. It’s only when the behavior becomes compulsive and divorced from reality that it’s a problem.

It’s also true that if there are no negative consequences, there’s no addiction. You might say, “I’m addicted to tv,” but unless you’re losing your job and your wife and your cat as a result of your tvwatching, it’s not an addiction.

Frankly, I don’t care if people are engaging in some kind of compulsive behavior, even if it involves drugs, as long as it’s not doing them or someone else harm.

Cooper: Even heroin?

Szalavitz: Sure. If you’re a rich person with no responsibilities and an infinite clean supply and a spouse who doesn’t mind, you probably would not be considered addicted under this definition. Of course, I’ve never encountered anyone like that in real life. Most people who use heroin every day — or other opioids like morphine, oxycodone, and opium — are unable to rein in their use when they need to, and that’s a negative consequence in itself. (...)

Cooper: Is recovery sometimes a matter of trading a harmful addiction for a less harmful, more socially acceptable one, like smoking?

Szalavitz: There are certainly situations where somebody replaces compulsive heroin use with, say, compulsive running. If this compulsive running is doing less harm, then you’re at least better off. If it’s doing no harm, you have achieved recovery.

People often refer to the “high” they get from activities like running or sky diving. We eventually have to wrestle with the fact that human beings will always want to get high. Every culture has intoxicants. Either we can recognize this and make available the least-harmful substances in the least-harmful settings, or we can go on destroying people’s lives and creating cartels in Central and South America by continuing prohibition. The war on drugs is not going to solve the problem. If it were, the problem would no longer exist. (...)

Cooper: The term “self-medicating” gets thrown around a lot. What’s your feeling about it?

Szalavitz: It’s an apt description of many addictions. If you are coping well in life, have no major problems, and can connect socially with others, you probably won’t become addicted, even if you discover a drug you enjoy. There are rare cases in which somebody has such a genetic predisposition for addiction to, say, alcohol that just one drink means trouble. But most people who experience euphoria from a drug do not go on to sacrifice their job or their marriage or their kids or everything they’ve worked for to keep taking it. It’s typically when your life is going badly and you don’t have anything to lose that a euphoric experience becomes incredibly appealing.

Addiction isn’t only about euphoria, though. What heroin really did for me was make me feel safe and comfortable and let me stop thinking everybody hated me. Today I get that same effect from Prozac. The euphoria was nice, but what really hooked me was just being able to feel ok. It was a classic case of self-medication.

A Harvard professor named Edward Khantzian developed the theory of self-medication, and for many years it was brushed aside because people insisted addiction was caused by genetics, even though they couldn’t explain how genes played a role. The self-medication idea became popular among people trying to treat alcoholism. There’s a school of thought that says alcoholism is caused by a vicious cycle: people drink to excess, get depressed about the consequences of their drinking, and then self-medicate their depression with more alcohol. Of course, that assumes everything was fine until you started drinking to excess. Maybe that happens sometimes, but the more logical explanation is that you’re anxious or depressed or unhappy in one of ten million ways, and the drug makes you feel good, so you continue taking it to the point that it makes you feel bad again. (...)

The current opioid problem presents a much greater danger than crack. Overdosing on crack is rare, but the death rate from opioid addiction is horrifying. It’s not just the drug that causes the problem. Only about a third of the people who try powerful opioids find them appealing, and only 10 to 20 percent become addicted. So there are people who love opioids but do not become addicted to them. It’s when your life is extremely stressful and you don’t have other ways to cope that heroin becomes attractive.

Cooper: Is that why poorer people are at a higher risk for addiction?

Szalavitz: Yes, if you’re poor, you tend to be under more stress. Also, when you develop an addiction, you’re likely to lose your job and end up poor.

We shouldn’t forget that middle-class people are at risk for addiction, too. And if you are extremely wealthy, you have an increased risk — perhaps because you have so much unstructured time. Rich people have unstructured time if they don’t have to work, and poor people have it if they don’t have a job. Too much idleness is also bad for someone with a mental illness, and about half of people with an addiction have a mental illness that exacerbates it.

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